bhargavi
Guru
OPERATION PERFORMED
1. Permanent pacemaker pulse generator explantation, left chest and reimplant
right chest with addition of new atrial and ventricular leads right chest.
2. Capping and abandoning of functional old atrial and the old right
ventricular lead left chest.
ANESTHESIA
MAC
COMPLICATIONS
None.
ESTIMATED BLOOD LOSS
5 ml
PRE OP DIAGNOSES
1. Squamous cell carcinoma left axilla requiring radiation therapy.
2. Sick sinus syndrome.
3. Tachybrady syndrome.
4. Right bundle branch block.
POST OP DIAGNOSES
The same.
HARDWARE IMPLANTED
Medtronic right atrial lead model number 4076 - 45, Serial Number BBL 10840342
Medtronic active fixation right ventricular lead model number 4076 - 52, serial
number BBL 1082837.
HARDWARE ABANDONED
1. Medtronic right atrial lead model 5568 - 45, Serial Number LDN 157871V,
left chest capped and reusable.
2. Medtronic active fixation right ventricular lead model number 5086 MR152,
Serial Number LFP 124864V left chest.
OPERATIVE NOTE
The patient brought to the electrophysiology laboratory in the postabsorptive
state. She was prepped and draped in usual sterile fashion and both left and
right chest were prepped and draped. Her left pacemaker site pocket was
anesthetized with 10 ml of 50/50 mixture of quarter percent Marcaine 2%
lidocaine. An incision was made medial to the deltopectoral groove and
dissection was performed down to the pocket where the pocket was incised
generator delivered. The leads capped and tied with O silk and buried in the
pocket. The pulse generator was wrapped in an antibiotic gauze and retained in
sterile condition for reimplantation on the right side. The left side incision
was closed in three layers, the lower two with running 2-0 Vicryl and cutaneous
with 4-0 Vicryl. The pocket had been irrigated with antibiotic solution.
Attention was then directed to the right chest. Her right chest was
anesthetized with 20 ml of a 50/50 mixture of quarter percent Marcaine 2%
lidocaine. An incision was made medial to the deltopectoral groove and
electrocautery was used to obtain hemostasis as well as perform dissection down
to pectoralis fascia were prepectoral pocket was created. Two separate
subclavian punctures placed guidewires in the subclavian vein. Tear away
sheath introducer leads into the superior vena cava where fluoroscopic guidance
assisted placement of fixation right ventricular lead into the right
ventricular apex and the active fixation atrial lead into the right atrial
appendage. Pacing and sensing thresholds were obtained. The new leads had an
R-wave of 5.1 millivolts, impedance 687 ohms with a threshold 0.5 volts at 0.5
milliseconds pulse width. The P-wave was 1.9 mV impedance 490 ohms with a
threshold of 1.4 volts at 0.5 milliseconds pulse width. Both leads were
anchored to the pectoralis fascia using O Ethilon. The new leads were secured
to the old pulse generator and placed in the pocket after irrigation with
antibiotic solution and hemostasis. The incision was closed in three layers,
the lower two with running 2-0 Vicryl cutaneous with 4-0 Vicryl. The device
was left programmed, MVP 60 - 120 with rate response off. The device was A
paced V sensing on leaving the laboratory. The patient was transferred to the
Postanesthesia Care Unit in stable condition for recovery from anesthesia.
Both wounds had Steri-Strips dry sterile dressing and Tegaderm placed.
THANKS IN ADVANCE
I AM THINKING 33217 ?
1. Permanent pacemaker pulse generator explantation, left chest and reimplant
right chest with addition of new atrial and ventricular leads right chest.
2. Capping and abandoning of functional old atrial and the old right
ventricular lead left chest.
ANESTHESIA
MAC
COMPLICATIONS
None.
ESTIMATED BLOOD LOSS
5 ml
PRE OP DIAGNOSES
1. Squamous cell carcinoma left axilla requiring radiation therapy.
2. Sick sinus syndrome.
3. Tachybrady syndrome.
4. Right bundle branch block.
POST OP DIAGNOSES
The same.
HARDWARE IMPLANTED
Medtronic right atrial lead model number 4076 - 45, Serial Number BBL 10840342
Medtronic active fixation right ventricular lead model number 4076 - 52, serial
number BBL 1082837.
HARDWARE ABANDONED
1. Medtronic right atrial lead model 5568 - 45, Serial Number LDN 157871V,
left chest capped and reusable.
2. Medtronic active fixation right ventricular lead model number 5086 MR152,
Serial Number LFP 124864V left chest.
OPERATIVE NOTE
The patient brought to the electrophysiology laboratory in the postabsorptive
state. She was prepped and draped in usual sterile fashion and both left and
right chest were prepped and draped. Her left pacemaker site pocket was
anesthetized with 10 ml of 50/50 mixture of quarter percent Marcaine 2%
lidocaine. An incision was made medial to the deltopectoral groove and
dissection was performed down to the pocket where the pocket was incised
generator delivered. The leads capped and tied with O silk and buried in the
pocket. The pulse generator was wrapped in an antibiotic gauze and retained in
sterile condition for reimplantation on the right side. The left side incision
was closed in three layers, the lower two with running 2-0 Vicryl and cutaneous
with 4-0 Vicryl. The pocket had been irrigated with antibiotic solution.
Attention was then directed to the right chest. Her right chest was
anesthetized with 20 ml of a 50/50 mixture of quarter percent Marcaine 2%
lidocaine. An incision was made medial to the deltopectoral groove and
electrocautery was used to obtain hemostasis as well as perform dissection down
to pectoralis fascia were prepectoral pocket was created. Two separate
subclavian punctures placed guidewires in the subclavian vein. Tear away
sheath introducer leads into the superior vena cava where fluoroscopic guidance
assisted placement of fixation right ventricular lead into the right
ventricular apex and the active fixation atrial lead into the right atrial
appendage. Pacing and sensing thresholds were obtained. The new leads had an
R-wave of 5.1 millivolts, impedance 687 ohms with a threshold 0.5 volts at 0.5
milliseconds pulse width. The P-wave was 1.9 mV impedance 490 ohms with a
threshold of 1.4 volts at 0.5 milliseconds pulse width. Both leads were
anchored to the pectoralis fascia using O Ethilon. The new leads were secured
to the old pulse generator and placed in the pocket after irrigation with
antibiotic solution and hemostasis. The incision was closed in three layers,
the lower two with running 2-0 Vicryl cutaneous with 4-0 Vicryl. The device
was left programmed, MVP 60 - 120 with rate response off. The device was A
paced V sensing on leaving the laboratory. The patient was transferred to the
Postanesthesia Care Unit in stable condition for recovery from anesthesia.
Both wounds had Steri-Strips dry sterile dressing and Tegaderm placed.
THANKS IN ADVANCE
I AM THINKING 33217 ?